The Multidisciplinary Clinical Research Center (MCRC) in Musculoskeletal Diseases at Dartmouth is committed to promoting rigorous clinical research through focused research collaborations and cross-disciplinary educational initiatives among diverse disciplines. These disciplines include orthopedic surgery, medicine, geriatrics, biostatistics, health services research, decision sciences, health economics, informatics and epidemiology, which all are critical for meeting the MCRC's objective of improving the health care quality and health for patients suffering from musculoskeletal diseases. The growth in infrastructure and methodological expertise associated with the NIAMS-sponsored Spine Patient Outcomes Research Trial (SPORT) has combined with large institutional investments in comparative effectiveness research to make this an opportune time to further develop the MCRC at Dartmouth. Based on a well-developed Methodology Core leveraging and complementing new institutional resources, an expanded research base will be provided with comprehensive methodological and administrative support. Three integral projects are planned within the MCRC: Project 1 will conduct comparative effectiveness research focused on secondary fracture prevention in a nationally-representative population of elders who have sustained a hip or other osteoporosis-related fracture. Project 2 will develop, validate, and evaluate a novel web-based treatment outcomes calculator for communicating individualized risk and benefit information to aid surgeons, primary care physicians and patients facing complex decisions related to surgery for back-pain related conditions. Project 3 (developmental) will explore the validity of claims-based methods to ascertain complications of surgery and develop a novel claims-based approach to safety surveillance using the biological agent Bone Morphogenetic Protein (BMP) as a case study. Through the Methodology Core, new educational opportunities will be provided for clinicians and researchers in training, thereby fostering new clinical research initiatives that will further improve the health of patients with musculoskeletal disease.